What Next In War Against Cancer?

May 08, 1986|By Joan Beck.

The numbers are as stark as death: We are losing the war against cancer.

The message in the figures is equally grim: Prospects for successful treatment and cure of many cancers are so bleak at this point that some researchers suggest shifting efforts and resources to preventing the disease. Finding this needle of a conclusion in a haystack of statistics isn`t easy. The number of Americans in age groups most prone to cancer is growing rapidly. Deaths from heart disease and other illnesses are declining, leaving more people to die of cancer. Better screening methods and public education efforts are leading to the detection of cancers that might have gone unnoticed in earlier years and may not all be potentially dangerous.

Statistics can be juggled to include or exclude some kinds of cancers

(superficial skin cancer, for example) or groups of victims. And there are success stories (childhood leukemia, Hodgkin`s disease, choriocarcinoma), major gains from early detection (cervical cancer) and other encouragements.

But during the two decades between 1962 and 1982, the total number of Americans dying from cancer increased 56 percent, from 278,562 to 433,795. Even taking into account increases in the number of people in cancer-prone years, deaths went up 8.7 percent.

The number of people being diagnosed as having cancer also went up markedly: 13 percent from 1973 to 1981, or 8.5 percent with adjustments for changes in the age and size of the population.

``Age-adjusted mortality rates have shown a slow and steady increase over several decades and there is no evidence of a recent downward trend,`` insist Dr. John C. Bailar III and Dr. Elaine M. Smith in the current issue of the New England Journal of Medicine.

There is ``no evidence that some 35 years of intense and growing efforts to improve the treatment of cancer have had much overall effect on the most fundamental measure of clinical outcome--death,`` these researchers say. Although rates of long-term survival vary from one kind of cancer to another and among individual patients, for ``cancer as a whole we have slowly lost ground. Overall, the effort to control cancer has failed.``

Given these discouragements, it may be good strategy to shift the main thrust of the war against cancer from treatment to prevention, conclude Bailar and Smith--and other researchers who have taken a sharp look at mortality rates. The first, most lethal target is obvious.

Bailar and Smith call the sharp and continuing rise in deaths from lung cancer resulting from cigarette smoking ``a medical, social and political scandal.`` Dr. John Cairns, in a recent Scientific American, notes that while chemotherapy may save the lives of 5,000 to 10,000 cancer victims a year, smoking takes at least 100,000.

Cairns suggests that governments have a built-in financial interest in not trying harder to reduce cigarette consumption. Federal and state governments get about $6 billion a year from taxes on tobacco and the U.S. saves about $10 billion a year in Social Security payments because smokers die prematurely, he says.

Causes of other major cancers are not as clear. But cancers occur at markedly different rates among different population groups, suggesting that they may, at least in part, be preventable, researchers say.

Except for cigarettes, it is not completely clear what other environmental triggers may cause cancer and in what circumstances and at what levels of exposure. Radiation certainly belongs on the list, but involves many unanswered questions. Estrogen is linked to endometrial cancer and DES to vaginal cancer in offspring of women who took it during pregnancy. Sunlight accounts for many superficial skin cancers. Patterns of sexual activity seem related to cervical cancer. Some other cancers can be traced to occupational hazards. The effects of diet, air pollution and exposure to toxic wastes are far less clear.

Resarchers who urge that more effort and money be spent on resarch to prevent cancer are right, of course. But this nation is rich enough and suffers so much from cancer that this should not mean cutting back on the search for what Bailar and Smith call ``the cure that always seems just out of reach.``